The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Nicholas J. Macmillan1, Gregory K. Spratt1, Andreana Walters1

Background: Research shows on average patients with chronic illnesses received 54.9 % of care recommended by treatment guidelines and COPD patients received 58% of recommended care. (1) Additionally, a recent study shows that spirometry is infrequently used in clinical practice for diagnosis of COPD and suggests opportunities for practice improvement. (2)

The purpose of this study was to determine whether the use of spirometry in the home care setting resulted in the identification of additional treatment needs based on the existing Global initiative for chronic Obstructive Lung Disease (GOLD) treatment guidelines.

A program was initiated whereby all non-OSA respiratory diagnosis patients on continuous service that were visited by a respiratory clinician (RC) were assessed with an inexpensive spirometer (Piko 6, nSpire). (3) Patients COPD stage was determined based on the values and treatment guidelines for that stage were compared to current treatment and differences were captured.
The data assessed were the absolute change in the number of differences identified and the difference identified per RC. The second measure was to account for difference attributable to normal variation in staffing levels.

For the period of time thirteen weeks prior to the introduction of spirometry compared to twelve weeks after, there was a 38% increase in the absolute medications need to meet treatment guidelines. This trend continued beyond the introduction of spirometry and there was an additional increase of 20% between the first eight weeks of spirometry use and the second eight weeks. Individual RC identification of medications needed to meet treatment guidelines for the same period increased 22.7% for the same period. The trend likewise continued by increasing 17.2% between the first eight weeks of spirometry use and the second eight weeks.

Underutilization of spirometry can lead to meaningful differences between current treatment and established treatment guidelines. The use of a simple spirometer assists clinicians in the staging of COPD and the identification of differences between current treatment and established treatment guidelines. CLINICAL IMPLICATIONS:

Using spirometry better identifies patient disease state and therapeutic needs.

Nothing to disclose.

(1) New England J of Med 348;26 June 26, 2003
(2) CHEST. 2007;132(2):403-409
(3) ERS Abstract (P1120) October 2007